Apr 1, 2015

I walked over, put my arm around her, put my head against her head and said -- Thursday. Then I give her a little squeeze.

One thing that drives Alzheimer's caregivers crazy is repetitive questions and repetitive behavior. I know this from the number of emails I receive on this issue, and the number of comments we get on the issue.

It is clear to me that a large fraction of patients with Alzheimer's disease ask the same things over and over. I understand how disconcerting this can be -- I was there once upon a time.

These kinds of situations and experiences helped me to envision Alzheimer's World, and then to start formalization my construct of Alzheimer's World.

For me, there are two communication worlds: real world and Alzheimer's World.

In real world, I communicate much in the same way that I always have. I decided that I was not going to try and change real world. I would keep it just as is.

In Alzheimer's World, the communication is very different than in real world. For one thing, there is only one other person in Alzheimer's World most of the time -- my mother. One thing that makes my mother different from the rest of us is that her short term memory is gone. It would be foolish of me to expect her to remember what I said a little while ago. She can't.

As Alzheimer's progresses, short term memory disappears. It no longer exists.

Once you accept and understand that short term memory is gone, you should not be surprised if a person with Alzheimer's asks the same questions repeatedly. They cannot remember if they asked a question -- once or ten times. You can remember because you are still in real world. Your short term memory is still working. They are in Alzheimer's World -- no memory world.

As I thought about this I came to a simple conclusion. Instead of trying to change Alzheimer's World, instead of trying to fight Alzheimer's World, not only would I accept Alzheimer's World as a reality, I would go into Alzheimer's World and learn how to communicate effectively.

Here is the first thing I learned. The fewer the words the better in Alzheimer's World.

So when my mother asks me --what day is it? The answer is Thursday. Not I already told you its Thursday or you just asked me that five minutes ago. Thursday.

You know what I learned? I learned this is really easy to do. And, I learned you don't get bent out of shape in Alzheimer's World when you keep it simple.

I learned something else. Once you finally accept that this is the way it is going to be, you might find yourself laughing or chuckling when the questions keep on coming. You fully expect what is going to happen -- in advance. You figured this out in real world -- by the way.

After a couple of years I thought to myself. It must be really disconcerting when you don't know what day, month, or year it is. I mean, how do you think you would feel if you never knew what day it was, or whether it was winter, spring, summer, or fall? You would probably feel nutty and disconcerted much of the time.

So I found myself thinking -- this must be really disconcerting to my mother. I continued to think about it more and more. I started thinking maybe this is one of the reasons my mother gets mean or starts acting crazy. If she doesn't know what day it is that must really be disconcerting and then think about all the other things she no longer knows or remembers -- it has to be unsettling to her. Yeah, I think so.

So I added another behavior to my arsenal of communication tools that I use in Alzheimer's World.

If my mother starts asking me a question over and over I think to myself, she must really want to know, or need to know. Maybe not knowing is disturbing to her.

Here is what I started doing. Instead of getting bent out of shape and giving her a completely exasperated response I started doing the opposite. I walked over, put my arm around her, put my head against her head and said -- Thursday. Then I give her a little squeeze.

Obviously over time, I started doing this more often and in different situations.

Guess what I learned? I learned that I was no longer exasperated, bent out of shape, or stressed out. Quite the opposite in fact. I felt good about myself. I felt good, not bad.

So you see, you do have a choice. You can accept that certain things are going to happen over and over. You can come to an understanding that these behaviors are not part of your real world, they are part of a new and very different world -- Alzheimer's World.

Soon you might conclude that you need to start developing some new and different communication strategies to communicate with someone that has Alzheimer's.

Soon you might learn that something that use to drive you up the wall can actually have the exact opposite effect -- it can make you feel good about yourself.

TIP.

You start feeling good about yourself and soon the person who has Alzheimer's will start feeling pretty good also. Instead of getting that nasty vibe from you, you will be sending a very different signal -- I care.

As you learn to communicate in Alzheimer's World you will be doing something that is very important. You will be creating an environment that is very safe and very secure. Once your Alzheimer's patient starts feeling safe and secure they will become kinder and more gentle.

If I treated you with respect and understanding wouldn't you be kinder and more gentle to me?

Before you know it you might learn the most important lesson of them all -- Alzheimer's World is very different than you think. Alzheimer's World is a good place.

I know that some of you might want to tell me a reason(s) this might not work.

In Alzheimer's World if you use too many words all you are really saying is Blah, Blah, Blah - Blah Blah.

One of the hardest things to do as an Alzheimer's caregiver is learning how to understand, cope, and communicate with a person living with dementia.

Learning how to communicate effectively requires change. How hard it is to change the way you have been doing things with a person you have known all of your life? How hard is it to change a pattern of communication that has been ingrained in you all your life?

Darn hard. Although, I might use a few different choice words to explain this if I was talking to you in person.

The bottom line here. Beyond a certain stage in the progression of Alzheimer's, communicating in the same way we have all our lives will not work well with a person living with dementia ... read more

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